Healthcare Provider Details

I. General information

NPI: 1811427800
Provider Name (Legal Business Name): HOZHO BEHAVIORAL HEALTH AND LIFE COACHING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 01/11/2020
Certification Date: 01/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11903 MAIN ST
FREDERICKSBURG VA
22408-7326
US

IV. Provider business mailing address

13006 DUBIN DR
SPOTSYLVANIA VA
22551-8012
US

V. Phone/Fax

Practice location:
  • Phone: 540-684-8962
  • Fax:
Mailing address:
  • Phone: 856-912-0314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904009633
License Number StateVA

VIII. Authorized Official

Name: MRS. JOYCE CATHERINE CORBIN MOYA
Title or Position: OWNER/OPERATOR
Credential: LCSW
Phone: 856-912-0314